Aging is a social and economic challenge of the highest importance and a multidisciplinary intervention seems to be a promising approach for improving the quality of life of elderly individuals. This project was designed aimed at promoting an active and healthy aging through the implementation of an intervention program based on the comprehensive geriatric assessment model (AGA@4life), focused on promoting health and wellbeing, independence and autonomy, mobility, and social inclusion. A non-randomized interventional study was designed to evaluate the effect of only a dietetic and nutritional approach (control group (CG)) and the combination of a tailored exercise program and a dietetic and nutritional approach (intervention group (IG)) in the biochemical and hematological profile of older adults in the framework of AGA@4life. The 34 participants enrolled, aged 65 years or over, were subject to a thorough baseline (T0) multidisciplinary diagnostic evaluation, including the gathering of clinical information and a battery of biochemical and hematological determinations, and reevaluated after eight weeks of intervention (T1). Between T0 and T1, an increase in albumin and total proteins serum levels were observed in both groups (p < 0.01); the hematological profile in CG and IG showed an increase in red cell count and hemoglobin (p < 0.05). In IG, an increase of HDL cholesterol (p < 0.001) and a decrease of triglycerides (p = 0.001) were still observed. The AGA@4life multidisciplinary intervention improved the hematological and biochemical profile of old adults, potentially contributing to delay the development of several aging comorbidities and increase the quality of life of participants.
Oxidative stress is defined as the imbalance between reactive species and antioxidant agents. One of the effects of oxidative stress is the normal process of cellular aging that stems from the accumulation of tissue damage. Epidemiological studies show that regular physical exercise prevents the injuries caused by aging. The objective was to evaluate whether the practice of hydrotherapy, in an elderly population, positively influenced the activity of the enzymes superoxide dismutase, glutathione peroxidase and reductase that act by reducing reactive species in the body. The study involved 37 participants aged ≥ 60 years, of both sexes, divided into experimental and control groups. The experimental group performed 15 hydrotherapy sessions. Enzyme activity was evaluated in two moments: T0-before the first session, and T1-after the last session, with blood collections conducted in both. In T1, there was a significant increase vs. T0 of glutathione peroxidase activity (57.72 ± 19.99 vs. 48.14 ± 17.22 U/g Hb) and glutathione reductase activity (100.18 ± 30.85 vs. 78.44 ± 21.26 U/L). Both sexes tended to show higher values at T1. We concluded that hydrotherapy proved to be a positive stimulus for the enzymatic antioxidant activity of the elderly, suggesting that a regular and moderate practice of physical exercise induces better and higher quality of life.
Idiopathic pulmonary hemosiderosis is a potentially fatal disease that results from episodes of alveolar hemorrhage of unknown origin. The clinical spectrum is varied, and anemia may constitute the only manifestation of illness, preceding other signs and symptoms by several months. We present the case of a 4 year-old child presenting with fever, vomiting and prostration, associated with pallor. He had microcytic and hypochromic anemia refractory to iron therapy. Gastrointestinal bleeding was ruled out after negative extensive etiological investigation. Subsequently, pulmonary infiltrates suggestive of alveolar hemorrhage were observed in the chest radiography. The cytological exam of the bronchoalveolar lavage showed hemosiderin-laden macrophages. After the etiological study, the diagnosis of idiopathic pulmonary hemosiderosis was made by exclusion. He was initiated on corticosteroid therapy, later associated to an immunosuppressive agent, with subsequent correction of anemia and of the radiological pattern. The patient is currently asymptomatic.
Background:Microangiopathic hemolytic anemias (MAHA) are characterized by the presence of hemolytic anemia (HA), related to red blood cell (RBC's) fragmentation, thrombocytopenia and hemosiderinuria due the intravascular hemolysis. The term thrombotic microangiopathy (TMA) is also used to describe syndromes characterized by AHMA, thrombocytopenia, and thrombotic lesions in small blood vessels such as Thrombotic Thrombocytopenic Purpura (TTP) and Hemolytic uremic syndrome (HUS). Although TTP and HUS are the prototypes of TMA / MAHA, there are other causes that should not be forgotten, such as MAHA by valvular leak.Aims:Perform the casuistry of the Hematology Service of a Central Hospital for a rare cause of hemolytic anemia.Methods:Parameterized search for the data of patients with MAHA and hemosiderinuria evaluated at a Hematology out patients clinic at a Central Hospital between January 2007 and March 2018.Results:9 patients with MAHA were identified with valvular leak, the mean age at diagnosis was 68 years and 6 were men (66%). All patients had mechanical heart valves: 66% mitral valve, 22% aortic valve and 11% both valves. The time from surgery to diagnosis of AHMA was ∼ 2 years. The mean Hb value was 8.4 mg/dL. All patients had RBC fragmentation. The mean value of DLH was 3773U/L, total bilirubin (TBil) was 1.9 mg/dL. 88% patients were supplemented with oral iron. Only 3 patients increase ∼ 1.5 g of Hb after 3 months of therapy. 1/3 patients were supplemented with EV iron; 1/3 needed blood transfusion. 66% underwent valvular leakage correction and of these 50% significantly improved Hb and hemolysis.Summary/Conclusion:A careful clinical history and the RBC morphology play a central role in the diagnosis of anemia. The MAHA due to leak valvular is a rare entity, but with a tendency to increase. Despite the small number of patients, the authors consider pertinent to present these data because this is a potentially reversible cause of anemia. The disproportionate high DHL level in relation to the TBilis a possible clue to the differential diagnosis of HA.
4672 INTRODUCTION: Reticulated platelets (rP) are young platelets, recently released from the bone marrow, and contain more cytoplasmic RNA elements than mature platelets. Considerable amount of evidence suggests that rP analysis may be useful in the investigation of platelet disorders. Automatic quantification methods have been developed; however, the methodology has not yet been standardized and validated in clinical practice. STUDY PURPOSE To analyze the rP percentage (rP%) in 168 samples, using software version v3 in Cell Dyn® Sapphire, in correlation with clinical data. MATERIAL AND METHODS: 168 samples analyzed in Cell Dyn® Sapphire, between March and August 2010, using CBC+RET methodology in the determination of: rP%, reticulocytes % (Ret%), platelet optical counts (PLTo) and mean platelet volume (VPM). Normal control samples (C) n=73; Patients: 20 with auto-immune haemolytic anemia (IHA); 8 with thrombocytopenic thrombotic purpura (TTP); 45 with immune thrombocytopenia (IT), 4 with bone marrow aplasia (BMA) and 18 thrombocythopenias of unknown cause (TUC). Mean difference between rP% in controls vs TUC samples calculated by t-student. Statistical analysis by StatView 5.0. RESULTS: C samples: median rP % =1.6, range=0.2-4.1, mean PLTo= 263×109/L, median MPV=8.5fL. IHA: median rP%= 1.9, range =0.6 – 12.5, mean PLTo=284×109/L, median MPV= 8.6, mean Ret%=12. TTP: median rP%=5.1, range=0.3-16.5, mean PLTo=185×109/L, median MPV=8.5. IT: median rP%=3.8, range=0.4-27.8, mean PLTo=56.8×109/L, median MPV=11.4. BMA: median rP%=4.1, range=0.3-6, mean PLTo=66.2×109/L, median MPV=11. TUC: median rP%=2.7, range=0.2-13.6, mean PLTo= 80.5×109/L, median MPV=11.1 Mean difference between rP% in C vs TUC samples: t=2.5, p=0.02. CONCLUSIONS: Median rP% values obtained in control group are in agreement with published data, despite the variation in the “normal” values between the authors. MPV and rP% in destructive thrombocytopenias (IT and TTP) are higher than in control group, in accord to immature platelets release by the bone marrow. IHA patients, despite the high Ret%, have a median rP% similar to the control group, demonstrating that rP counts are not over-estimated by the high number of reticulocytes. In BMA rP% is higher than expected, however the number of samples analyzed is very low. The statistically significant mean difference between rP% in Control vs TUC samples makes the immune cause for the thrombocytopenia very likely. Due to its simplicity, ready availability and information provided by this methodology, it has a good potential to be a useful tool in the investigation of thrombocytopenias of unknown cause. Disclosures: No relevant conflicts of interest to declare.
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